| Susan G. Ellis, Ph.d., P.a. | |
|
3233 E Bay Dr Suite 100 Largo FL 33771-1900 | |
| (727) 536-2200 | |
| (727) 531-5088 |
| Full Name | Susan G. Ellis, Ph.d., P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 3233 E Bay Dr, Largo, Florida |
| Authorized Official Name and Position | Susan G. Ellis (PRESIDENT) |
| Authorized Official Contact | 7275362200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan G. Ellis, Ph.d., P.a. 3233 E Bay Dr Suite 100 Largo FL 33771-1900 Ph: (727) 536-2200 | Susan G. Ellis, Ph.d., P.a. 3233 E Bay Dr Suite 100 Largo FL 33771-1900 Ph: (727) 536-2200 |
| NPI Number | 1801125869 |
|---|---|
| Provider Enumeration Date | 12/21/2009 |
| Last Update Date | 12/21/2009 |
| Medicare PECOS PAC ID | 2466471081 |
|---|---|
| Medicare Enrollment ID | O20051114000313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801125869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY2173 (Florida) | Primary |
| Provider Name | Susan G Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578633350 PECOS PAC ID: 7618996232 Enrollment ID: I20051115000147 |
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